Melasma — Those Ugly Brown Spots on Your Face

Just when I think my skin has evened out, here comes the sun! One day into the warmer weather, and I look like an old banana.

Years ago, a little sun made me look healthier and younger, now the opposite seems to be true. Ever since the two youngest monkeys were born, I have a big brown dot on my cheek and, when I’m not careful in the sun, a dark line on my upper lip.

Next to wrinkles, nothing makes you look your age (or worse) than brown spots and a false mustache.

Why does it happen?

The color making cells (melanocytes) in the skin overreact. It occurs much more often in women (shocker … why would men have to deal with anything else???) and in darker skinned people.

When does it happen?

Sun exposure makes it worse.

It can “just” happen, but many women notice worsening during pregnancy. During this blessed time, it gets a special name, chloasma: the mask of pregnancy. Just when you thought you couldn’t feel worse …

Birth control pills and hormonal replacement may also cause the melanocytes to darken.

What to do

– Wear sunscreen every day. I wear SPF 30 religiously on my face, but when I’m going to be in the bright sun midday, I add an SPF 55 to the dark spots. This seems to help balance out the shading a bit.

– Choose gentle skin products, as anything that irritates the skin, can make the melasma worse.

– Avoid waxing these areas.

– Skin bleaching creams especially those prescribed by a physician, can help a lot. Often a second cream will be prescribed to enhance the effectiveness of the skin lightener.

– Dermatologists and/or cosmetologists can perform procedures like chemical peels and microdermabrasion.

Remember, there is always risk for the melasma to return, so even when you aren’t seeing those spots and smudges, focus on sun protection and avoidance of any triggers.

This is me … it is early and I have no makeup on. Be kind. I know, I know — I’m making an appointment now.


Posted in Dermatology | Leave a comment

Summer Reading – Tips & Tactics

“Lorelei, how are you doing with your summer reading?”

“Great, mom! I’ll see you later.”

Later: “Lorelei, when you said you were doing great with your summer reading, can you please be more specific?”

“I’m up to page 7 in my first book!”

Oh boy, here we go again. We enter every summer with the best of intentions. We are going to read early and often. Not only are we going to bang out the reading lists, we are going to impress our next year’s teacher with a litany of masterpieces read. Then, in the blink of an eye, it is September. Reading logs, when we can find them, are stained, wrinkled, and pathetically scant. The panic (their’s) and the guilt (mine) start to set in. One year, Madelyn spent the last two days of summer under her covers, reading books with a flashlight through red-rimmed, tear filled eyes. All the while I was saying, I told you so. But, the truth is, I’m not really sure I did tell her so. I probably threw out a couple, “You should bring your book to the beach,” and “Why don’t you turn off the TV and pick up a book?” but I didn’t truly help her stay on track to meet her summer goals. I have learned from my mistakes.

1. You CANNOT, I repeat, CANNOT wait until August to start thinking about summer reading. Even if one month were enough time, August is filled with vacations, social events and angst as we all try to soak in the last rays of sun. You may be way too busy to pester your kids by then.

2. Put the reading logs in a visible, accessible place. If possible, leave them on the fridge or a bulletin board. If you have more than one child in school, there’s nothing like a little sibling rivalry to light the fire under a lazy butt. More importantly, you’ll be able to see exactly where your kids stand in terms of reaching their goals.

3. Book choice is everything. Help your kids pick the right books for them. Stick to their reading level and find stories to which they can relate. Don’t assume the books you loved or an older child loved will be a favorite of another child. When my kids say, “I don’t like to read,” after I shake a fist at the heavens for giving me a child who would say such a stupid thing, I respond. “Saying you don’t like to read is like saying you don’t like to eat. We all have different tastes. You just have to find the right book for you.” Ask friends who share similar interests, librarians and teachers for suggestions. And, remember, it is O.K. to stop a book midway. I’ve made the mistake (many times because I am a slow learner) of telling my kids to power through a book they hate just so they can add it to the list. In the time it took them to finish the book they dreaded, they could have read two they loved.

4. Read with them. My kids love when I pick up the same book they are reading. Whether you have a high school student tackling Great Expectations or a 2nd grader reading Super Fudge, all kids, all people, love to share their impressions and thoughts about a book with someone literally on the same page. Encourage an environment which supports summer reading. Leave books on tables, talk about books, read where your kids can see you.

5. As a last resort, and one I’ve been forced to use, set specific reading goals. Yes, this will then feel more like a job for you and homework for them, but the reward will be simply getting it done. While I would love my children to relish in the joy of days relaxing with a great book, during some summers, with some kids, this has to be enough. The more they read, even begrudgingly, the better chance they will eventually come to appreciate the written word.

It is important to remember reading is the backbone of academic success. Having to read over the summer is not a punishment, no matter how you are feeling when you’d rather sip a cocktail than read a children’s book or yell at your kids. Don’t take your child’s side over their teacher’s. This will only give them an excuse to blow off what may possibly be their only academic summer stimulation. I know the madness that is the end of the school year still has your head spinning. The imprint on my forehead from the tire tracks on the Mack truck that is Spring parenting is just beginning to fade. The last thing I want to do is to resurrect my inner drill sergeant, but believe me, work on the reading now before it is too late and the beginning of the school year will thank you for it.

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Puffy Eyes? What to do …

I’ve never been a morning person, and firmly I believe the only social events happening before noon should be funerals. Morning has never been a good look for me, but this is becoming more and more of a problem the older I get. Between wrinkles, gravity and a seemingly overabundance of eyelid, my reflection first thing in the a.m. is enough to make me avoid the mirror. I can hide for a while behind shades, but eventually someone wants to go inside.

Then, on top of a general tired eye, I am periodically having what I’ve come to affectionately call Pufferitis. If it sounds like a medical diagnosis, I have an excuse. Pufferitis is a unexplainable swelling of the fragile skin around either one or both eyes which give one the appearance of an 85 year old woman. It doesn’t clear quickly and has been know to frighten small children.

O.K. What to do …

First, prevent tired eyes in the first place. I know a few of these are laughable, especially if you’re a mom, but I have to include them for those who have the luxury of time or really good childcare.

1. Get a good night’s sleep, especially before an important meeting.

2. Avoid alcohol.

(Now,  things you can do.)

3. Drink plenty of fluids, as staying more hydrated will prevent bloating and puffiness.

4. Avoid salty foods. When I first fell in love with a good Dirty Martini, my Pufferitis was at an all time high. I blame the vodka for how long it took me to connect the swelling and the salty olive juice. See below for a list of foods high in sodium.

5. Don’t rub your eyes during the day or before bed and look for triggers. Allergies can cause swollen eyes, so be on the lookout for any food, cream, laundry detergent, or environmental exposure which seems to worsen this symptom.

Treating Pufferitis

1. As soon as you get up, drink a tall glass of water, then have your daily fix of caffeine.

2. Use eye creams with caffeine or for a cheaper fix, soak two teabags in cold water, lie down and rest on your eyes. The caffeine helps to constrict blood vessels.

3. Anything cold works well. Cold cucumber slices, a cold spoon or simply an ice pack over a wash cloth will help.

4. Put butt cream on your eyes. There are mixed reviews about Preparation H and puffy eyes, but my personal opinion, it works. Make sure you don’t get any inside your eyes. Also, don’t get in the habit of using it daily because it contains a steroid which can, over time, cause thinning of the skin. In a pinch, I say go for it.

5. Add an eye cream with Retinol, a form of vitamin A, to your daily skincare regimen. A doctor can prescribe a stronger dose, but you can pick up a reasonably priced one at your local drugstore. I’ve been using a L’oreal product, and I’m very happy with it.

Bottom line: If you live a normal life, with stress, booze, lack of sleep and Chinese food, you will have to contend with Pufferitis. Pick up a hemorrhoid cream, throw a couple spoons in the fridge and start drinking your Martinis straight up.

Foods with lots of salt that may surprise you:


Chips, canned soups, pretzels, and take-out are known to be high in sodium. But, did you know these also have a high salt content?

- cottage cheese

- marinades, salad dressings, BBQ sauce, ketchup

- breakfast cereals

- bagels

- sandwiches

- packaged baked goods

- veggie burgers

- pancakes

Bottom line: If you are trying to avoid salt for health or vanity reasons, check the label. It is recommended we consume only 1500mg/day. We only need about 200 – 500mg/day.


Posted in Eyes, Prevention, Uncategorized | Leave a comment

Don’t Forget Aging Hands

I was at a party a few years back and I met this beautiful woman who I thought was my age or younger. I was probably about 37 at the time. Somehow during the conversation, it came out she was more than ten years older than me. I wanted to pepper her with questions. “What cream do you use?” “How much water do you drink?” “What’s the name of your plastic surgeon?” You know, the usual party banter. I refrained and just said something stupid like, “I hope I look as good as you when I’m THAT old!”

Later, I was sitting with a friend and I pointed out the woman to him.

“Isn’t she beautiful?” I asked.

“She is,” he replied.

“How old do you think she is?” I couldn’t wait to shock him with her age.

“48-49.” He didn’t even hesitate.

Annoyed because that must mean I also looked close to 50, I asked him how he could possibly think she was 49 years old when she looked so young.

“Her hands,” he answered. “You can always tell how old a woman is by looking at her hands.

DAMN! One more body part to worry about.

So, since I am as vain as the next girl, I now pay a little more attention to my hands. Anything that goes on my face goes on my hands — sunscreen, lotion, retinol, etc. The skin on your hands is thin and fragile and can start to look older than the rest of you. Age spots, wrinkles, dryness, redness and saggy skin will all reveal your age faster than you can imagine.

Take these steps to keep hands young and healthy:

1. Use soaps with built in moisturizers to avoid dryness.

2. Make a homemade scrub with equal parts olive oil and sugar and exfoliate the backs of your hands weekly. Do it while you are waiting for the water to boil.

3. Use a hand cream with SPF and glycerin during the day.

4. Take care of your nails by using oil on the nailbeds and cuticles and by maintaining a well balanced diet, with lots of fruits, vegetables and water.

5. At night, use an anti-wrinkle cream that also targets dark spots.

As you grow older, you will discover that you have two hands, one for helping yourself, the other for helping others.

Audrey Hepburn

I sometimes look at my hands and see my mother’s. I don’t know if it is how they look or the way I gesture. When I recognize this resemblance to my mom, I can appreciate all the lines and spots and veins. These hands have held the hands of ones just born and ones leaving this world. They’ve been washed of blood and dirt and tears and paint and flour and guilt. With all they’ve been through, it is actually amazing they don’t look older. Even though I appreciate the wear and tear, I’m still using sunscreen;)

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Cramps in Your Legs and Feet

With the World Cup in full swing (GO U.S.A.!!), we will be witnessing lots of physically fit, strong men get taken down by a leg cramp. I am sympathetic. When I was enormously pregnant with my first child, I woke up screaming almost every night. Sometimes, it was because my sleeping brain conjured up nightmarish images of Sigourney Weaver “giving birth” to an alien, but more often, it was from the intense pain of calf cramps. The suddenness and intensity with which lower extremity muscle cramps comes on could bring Vin Diesel to his knees.

Why do they occur, how can you prevent, and how can you make them go away fast?


- Pregnancy, because of diminished stores of minerals like magnesium and calcium.

- Dehydration, which decreases blood flow to your muscles.

- Overuse from exercise or injury.

- Certain medical conditions which decrease blood flow to the lower extremities.

- Some medications, including birth control pills and diuretics.

- Standing for a long time or maintaining an awkward position.


- Avoid Pregnancy and when that’s not possible, avoid dehydration. Drink plenty of fluids and avoid those with caffeine which will worsen dehydration.

- Maintain a healthy diet with foods rich in potassium, magnesium and calcium.

- Stretch every day.

- Do not increase the intensity of your workout suddenly.

- Don’t wear high heels for extended periods of time.



- My best advice is to move your other leg. The goal is to get more blood flowing to the effected muscle. It is so painful to move the cramped leg or foot. Moving the other one will tell your brain to send more blood to both legs.

- As hard as it may be, stand up and try to walk around. Especially if you are pregnant, use care when putting pressure on your legs, as there is a risk the cramped leg can give out causing a fall. Hold onto something and start slow.

- Apply gentle massage, or better yet, have your partner do it for you.

- If the cramp persists, try warm water.

- For the ache after the intense pain has passed, Advil or Tylenol and stretching should do the trick.

If you are prone to cramping, focus on prevention. If that doesn’t work, it has been my experience the louder you yell, the more sympathy you will get. If you have to suffer the pain, you may as well let it work for you.


Posted in Musculo-skeletal, Nutrition | Leave a comment

Why Middle School Can Ruin Your Marriage

I am starting to understand why so many divorces happen when the kids are in middle school. There is no time or energy for sex.

For years, I listened to mothers of older kids complain about how busy they were. “My day really starts at 3pm.” “I don’t have a minute to myself.” “Our schedule is crazy!” With infants in smelly diapers, snotty little toddlers attached to my legs and an ever present, yet unidentifiable stain on my right shoulder, I wasn’t very sympathetic. I thought these were just excuses, so stay-at-home moms could assuage their guilt for having 6-7 hours of free time every day.  Older kids seemed so easy. They don’t cry, they don’t need their butts wiped and most importantly, they are in school ALL DAY. How could this possibly be hard? Now, I am starting to get it.

With a couple four year olds at home and a job, I still don’t have any downtime, but I do understand just how crazy the after school rush can be. I am bombing around town in my environmentally irresponsible car for what seems like hours each day, often well after dark. There are kids to drop off and pick up, dinners to prepare, homework to assist and … wait, what was the other thing??? Oh, yes, a marriage to nurture. With all the extra-curricular madness on the evenings and the weekends it is too easy to ignore your most important relationship.

Larry walks in from a long day at work, maybe has time to change his clothes, and then, needs to jump in with two feet to help get everyone where they need to be, answer homework questions and spend some time with the little guys — the last task being a real luxury which only happens on a rare, easy night. We are often two ships — two busy, aging, exhausted ships — passing in the night. And when we finally pass each other in the bedroom, Larry is ready for adult playtime. I, on the other hand, find it harder to jump right into it when we haven’t connected all day, or worse, when we’ve connected, but in a less than loving way. (e.g. “Did you pick up Serena?” “No, I thought I was getting Lorelei and YOU were getting Serena.”) Barking orders, juggling schedules and managing homework does not turn me on … maybe that’s just me. A cool breeze can turn Larry on.

When the kids were small, even though we may have been more physically tired, we had our nights together. We put the kids to bed and opened the wine. We talked and caught up or watched a movie and relaxed, silently enjoying each other’s company. Now, by the time we get everyone home, eat some dinner, get the boys to bed and help with homework, the night is over.

In general, we have a great marriage. I feel so fortunate to be sharing this craziness with a true partner and a real friend. But, like all relationships, ours requires attention and some work. A lot of the work is fun, especially making sure our sex life doesn’t suffer. The more intimate we are, the happier our union. Having five kids to raise means we often have to divide and conquer. The more we divide though, the more our emotional  connection suffers. While you are in the throes of the chaos, it is hard to think big picture. But, it is especially when you are in the throes of chaos that you need to think big picture.

Remember, one day, your children will leave (the good Lord willing) and you will be left staring at your spouse. You will have no school or sports to obsess over. You will have no family dinner to prepare. You will have no one to live vicariously through. You will be alone with the person you chose to spend your life with. Don’t wait until then to rekindle the flame. Think of it like the burner on the stove and keep it going all the time. You don’t have to aim for a full boil, you’ll end up embarrassing your kids, but you should aim for a constant simmer.

Here are five simple tips/reminders to keep the love alive. I realize this post sounds a bit like a soft rock 80s ballad. So be it. I hear that was a good decade for sexual satisfaction.

- It is okay to be affectionate in front of your kids. A loving home is a great gift.

- Be respectful and kind to your spouse at all times — or you know, as often as you can. Do not make your child your ally against your partner. It is unfair to them and damaging to a marriage.

- Make time each day, even if it is just a few moments, for each other. The kids WILL wait. You are the grown up, you can tell them to.

- Separate your children’s problems and pressures from your own. You already did adolescence. You don’t have to do it again.

- And finally, like a Nike T-shirt, Just Do It. Sex begets sex. If you are in a dry spell, don’t wait for fireworks. Even if you are exhausted or aren’t feeling particularly sexy, do it anyway. I guarantee, once you get going, you’ll wonder why you waited so long.

Remember, intimacy is really the only thing that makes your relationship with your partner different than all your other relationships. Don’t give it up for the sake of the kids. That’s how they got here in the first place.



Posted in Parenting, Uncategorized | Leave a comment

Breakfast May Not Be the Most Important Meal After All

I don’t eat breakfast … gasp! When I tell people this, I often get a, “You’re a doctor … you should know better!” or a “Breakfast is the most important meal of the day!” response. Now, the American Journal of Clinical Nutrition is supporting my no breakfast habit. They published an study which suggests there is no difference in weight loss between those who eat breakfast and those who skip breakfast. CNN provides a good summary. There is nothing definitive about the study, nothing that says don’t eat breakfast and you will lose weight. What it does say is that it may not make a difference after all. Not to toot my own horn, but that’s what I’ve been saying all along.

Diet and nutrition, especially when it comes to weight loss, is a very individual thing. The one-fits-all mentality is never going to work. We all have different metabolisms, different tastes, different ability to make certain “diets” and routines work for us.

I don’t wake up hungry and usually only start to get hungry about noon or 1 o’clock. When I force myself to eat in the morning, I am starving and tired all day. I end up either miserable from what feels like deprivation or giving in and snacking. I know I take in more calories when I eat breakfast. The weight maintenance routine which works for me is simply, “Eat Less, Move More.” Unless I am socializing and food is a part of it, I try to only eat when I’m hungry. This works for me.

I am not suggesting this will work for you. I have friends who say they could not make it out the door without breakfast. If you need food in the morning to get you going, try things that are filling but not heavy, like oatmeal and fruit. Focus on fiber and protein and avoid sugar.

I love this study because it underscores an essential aspect of weight loss … we are all different. Don’t change habits that are working for you because a celebrity touts a new diet or because someone thinks they know better. If you need to lose weight, find a routine that makes you feel good. Your body will speak to you. Be sure to listen.

Posted in Dieting, Uncategorized | Leave a comment

Texan Tick on a Rampage?

My daughter’s fifth grade class had an overnight encampment last week, and of course, hovering moms that we are, there were many concerns. Would they be warm enough, would they have enough to eat, would they be safe out in the scary school backyard? Silly worries, because of course, even soft suburban kids can survive one night in the “great outdoors”. But, one mom brought up a legitimate concern. She asked me if we should be checking for ticks when they came home. Absolutely is the answer. You should be checking kids after being outdoors in any grassy or wooded area. We all know about Lyme disease, but seems we have a new reason to check.

The state that brought us cowboy boots and Friday Night Lights is now sending atick-borne illness our way. Little is known about the Heartland Virus which is spread by the lone star tick. Recently, two people have died from its complications. So far, it has only affected people in Missouri and Tennessee.

Initial symptoms are similar to flu symptoms, including fever, fatigue, muscle aches, nausea and diarrhea. While cases have only been reported in a few states, but even in areas not thought to breed this type of tick, these cases underscore the importance of seeing a doctor when you are ill and letting her know if you have spend time outdoors.

This summer, especially if you are camping or hiking, check for ticks. I usually remember  to do this after I’ve poured my second glass of chardonnay on a beautiful summer night. It’s a drag. Do it anyway. The Heartland virus was only discovered a couple of years ago. Who knows what else might be lurking in these little buggers?

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Posted in Infectious disease, Kids | Leave a comment